


The Greatest Unknown

by conn8d



Category: Grey's Anatomy
Genre: F/M, Gen
Language: English
Status: In-Progress
Published: 2013-09-28
Updated: 2014-03-19
Packaged: 2017-12-27 20:28:36
Rating: Teen And Up Audiences
Warnings: No Archive Warnings Apply
Chapters: 3
Words: 19,961
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/983255
Author URL: https://archiveofourown.org/users/conn8d/pseuds/conn8d
Summary: <blockquote class="userstuff">
              <p>Alex Karev never thought he'd ever get a shot at normalcy. He was too messed up for that. But the life he's built with April is everything Alex never dreamed he could have. That is, until the skeletons of his own past threaten to unravel everything. Sequel to Nobody Knows Where You Might End Up. Alex/April, Alex/Mer friendship. Canon through S8E10.</p>
            </blockquote>





	1. Chapter 1

**A/N: Hello guys! For those that are interested in some continuing AK2 goodness, here is my promised sequel to Nobody Knows Where You Might End Up. **This picks up five year after the end of that story.** **I highly recommend you read that one first; it will put a lot of things in better context if you do. If you don't, I think you can still have an enjoyable time reading this one, but be aware that April and Alex are married, she has a bad leg from an injury, Izzie used one of the embryos and Lexie Grey did not die.**  Again with the usual disclaimer I know nothing about medicine and everything that appears here was researched using google. Lots of interesting twists and turns coming up in this one, so hang on for the ride. Thank you so much for reading and please do let me know what you think!**

* * *

_People act like fear is a weakness. Like it's this terrible Achilles heel that we should all strive to avoid in life. We act as though you are defective if you admit to your fears. If you succumb, you lose, right? Gotta be strong, we say. Get over it. Man up. And all of that. But the thing is, we all have fears. They come in all different shapes and sizes. They can be internal or external. About ourselves or the people we love. They can even be totally irrational. But the feeling is not. Fear is a very real thing._   


 

"Adam's in the kitchen with Mama," Adam Karev sang happily in his chair as he dug into his breakfast, making his own words to a familiar tune, which was one of his favorites at the moment.

April laughed and turned to look at the pajama clad red haired boy.

"Are you singing again?" she joked.

He responded affirmatively, flashing a dimpled grin and lifting his chin in the air in an emphatic nod. Adam was a big fan of singing. And making up his own words for songs. And talking. And eating. Especially in the morning. April shook her head fondly and continued to prepare her own breakfast at the counter as her six year old son continued his song at the kitchen table.

"And Audrey's in the kitchen al-so-o-o-oh," the boy continued, drumming his hands on the table to the tune. "We're in the kitchen with Mom-my!"

He shouted the last high note and paused dramatically as April sat down at the table with her eggs and toast between her two children. Her three year old toddler daughter ate her breakfast, quietly placing small pieces of cereal into her mouth as she watched her brother with wide hazel eyes. Locks of fine tousled brown hair fell on her forehead and April reached out to brush them back. The girl continued to eat.

Audrey took after her father in terms of morning attitude. Actually, as it was turning out, Audrey took after her father in a lot of attitudes. Pouting included.

Adam shot his mother a dimpled grin and concluded, "Eatin our cheerios!"

Joining him in the rest of the chorus, April sang, "Fee-fi fiddly di-day, fee-fi fiddly di-do-oh-oh-oh..."

"Freakin' A," Alex grumbled, shuffling into the kitchen, rubbing a hand down the back of his head and scratching at his belly.

April chose to ignore his word choice. There were bigger battles to be fought. Alex had gotten a lot better with his language since they had their children, but there were times he slipped up. He was not and never would be a morning person, no matter how many early shifts he worked at Seattle Grace. And, so far, neither of the kids had parroted any of their father's more colorful phrases.

Thank goodness.

Adam's face lit up and he turned around in his seat, "Daddy!"

"Morning dude," Alex grinned, leaning down to kiss the top of Audrey's head and then April's cheek.

"I'm like a wooster!" Adam said happily, cramming his mouth full of cereal. He chewed loudly and spoke, "I wake everyone up in da morning with my voice."

"Chew with your mouth closed," April instructed gently. "Swallow first. Then talk."

Alex smirked and waited for the boy to finished his mouthful before asking, "That's better than an alarm clock..."

"Yeah."

"You know, you going to get to play with real roosters on Grandpa and Grandma's farm when you go for your visit..." he explained to the child carefully. "While Mommy and Daddy are in Africa."

In 4 days, April and Alex were scheduled to go to Malawi, to run special crash courses in pediatric and trauma surgery at one of the training center's set up by Alex and Arizona's foundation. They'd now expanded to operating 3 locations, and Lucy Fields had been able to drum up a lot of local support. Alex had been to Africa four times in the past five years, teaching short term 'master classes' but April herself had never gone before.

Between the bum leg and the two kids, she just didn't think it was a feasible idea.

But now that it was almost summer, and Adam was graduating kindergarten that afternoon, and Audrey was potty trained, April thought it might be a doable thing. Alex and Arizona and the foundation had set up a good system of teaching. It wasn't that she didn't want to participate. It was just that parts of April's circumstances made her hesitate. What about her children? Her mobility? Then again, watching Alex over the years had demonstrated just how valuable and effective a short stint with a good teacher would be.

Certainly, trauma training would be of use to young surgeon's in Malawi, and it was one specialty that hadn't been as well represented in visiting surgeons. So, after much discussion, Alex had convinced April that did have something to offer, and she agreed to join him for a 14 day teaching course in Malawi. However, she still worried that her children would miss her. She knew she would ache for them. She also knew that her parents were capable and loved having the chance to care for her kids, but April was still apprehensive about leaving them.

Her son however, was not. He was excited, and had in fact enjoyed all of his previous (albeit shorter) stays in Cook Ohio with his Kepner grandparents. April and Alex had talked to both Adam and Audrey about the upcoming trip, introducing the idea to them slowly over a period of months so they would be used to it.

"I know," Adam said confidently, licking the back side of his spoon. "It's gonna be fun. There's gonna be cows and horsies and piggies. I like the farm."

"Good," April said, smiling approvingly. "And you know we'll only be gone for 14 days. That's not so bad."

She didn't know if she was trying to reassure herself or her son. Maybe both.

"It's two hands and four toes, right, Mama?"

Chuckling April nodded. Alex had had the brilliant idea of teaching Adam to count the days using his body parts. It was funny, but it worked.

"You both will have a blast on the farm," Alex continued, walking over to the counter and dishing a plate of eggs for himself. He glanced back to Audrey and prodded, "Can you say farm, Aud? Farm?"

The toddler didn't meet her father's gaze and continued to chew her breakfast slowly.

Projecting more than normal morning enthusiasm, April joined in, "Farm? You can say it."

"Farm! Farm," Adam piped up, turning to his sister's booster seat. "You can say it Audrey. I've heard you before!"

Adam had been an early talker for a boy, and once he'd started the rest was history. At Audrey's age, Adam was able to carry on long and drawn out conversations. Alex and April had been expecting a similar trajectory for their daughter, but the reality was very different. All kids developed at different rates, April knew. Her nieces all talked at varying ages, and her stepson Kyle took longer than Adam to perfect a lot of his speech. The children of her co-workers were another great example April could think of about the vastly different development rates kids could have.

When Zola was three, Meredith and Derek had had to deal with chatterbox syndrome, while Arizona, Callie, and Mark had to practically wring every single syllable from Sofia's lips. Granted, Sofia had been born a micro preemie, so there were bound to be developmental delays somewhere. They were all actually just really lucky that for the most part now, things had balanced out. Except for the need to wear glasses, Sofia had caught up with Zola and other children her age.

Audrey's case however, couldn't really be explained by premature birth. In fact, April's daughter had been born a week and a half after her due date, and had weight a whole 6 ounces more than her 9 pound brother. It seemed that Karev babies were large. So, April knew that her daughter's tendency toward silence was not a result of being born too early.

The thing was, she suspected Audrey was capable of far more than she would usually display. There were times when the little girl spoke very well and clearly the words she knew, and April always noticed how carefully the child payed attention to certain things. Audrey loved sitting on Alex's lap during all manner of sports games on tv, and would listen intently for hours when April read the children stories, well beyond the capabilities of her sometimes fidgety big brothers. She just knew her daughter could understand so much.

Sometimes April was certain that the girl even understood her father's sarcasm, offering only a small wry smirk at some of his more ironic comments in contrast to Adam's unfailing belief in most of what Alex said. Given the right circumstances, Audrey was very sweet, if occasionally moody like Alex and Amber. It was just a Karev thing.

But sometimes that was why April worried. Because another demonstrated Karev trait was schizophrenia, mental instability, and a whole host of possibilities that she didn't even want to think about.

Maybe she was just being paranoid.

Shaking herself, April returned her attention to the table and the present. There wasn't any reason to get freaked out. Kids really did develop at different rates. Audrey's pediatrician always said so. And Alex worked with kids all the time. He never acted worried. He just did what everyone else did, constantly trying to coax Audrey to engage outside of her comfort zone.

Audrey looked up from her bowl of cereal, chewing carefully and repeatedly running her fingers down the smooth plastic arms of her booster seat, finally offering a faint, but defiant, "No wanna."

Though it wasn't clear whether the girl was referring to having to spend time on the farm with her grandparents or being asked to say farm, the comment made April feel an absurd sense of relief. Audrey was not always in lala land. It was early. Her daughter had never been a morning person.

The family of four finished their breakfast, with Adam's excitement over the afternoon's graduation ceremony dominating the rest of the conversation. He was so excited to start first grade in the fall. April rolled her eyes at the excitement of her son as he waxed on proudly that being a first grader meant that he was going to 'real' school, like Sofia, Zola, and his brother Kyle. It didn't seem that he quite understood that he would still be exactly the same number of years behind his older friends as he was as a kindergartner. He idolized his older friends, and his step brother in particular, but sometimes the age gap between them, combined with the fact that they didn't live in the same household full time, caused friction between Kyle and Adam.

Izzie, Alex, and April had each had to break up their fair share of arguments, and on rare occasion, even a few fights between the two boys. Hopefully, nothing would happen that afternoon.

After they finished eating, April gathered up the bowls and plates, loading them in the dishwasher while Alex took the kids upstairs to start getting ready for the graduation ceremony. Hearing the sounds of shower water coming from upstairs, she took the opportunity to quickly clean the rest of the kitchen, pulling out the broom and sweeping discarded cheerios from beneath Adam and Audrey's chairs. Even though she had the day off from work, with two children around, there was always something that needed to be cleaned.

April took her opportunities when they came. She trusted Alex with this part morning routine. Generally.

By the time she'd finished cleaning up, April was very aware of the lack of noise coming from upstairs. She set down her dish towel and pursed her lips, padding in her socks across the kitchen floor and up the stairs to see what was going on. Even though the ceremony wasn't until mid afternoon, April had a schedule in mind that she wanted everyone to keep. The upstairs was suspiciously quiet, given that Alex, Audrey, and Adam were supposed to be getting ready.

Walking past Adam's room. April peered in to find it empty, with his neatly pressed little suit still hanging exactly where she'd left it. She turned around and poked her head in Audrey's room only to find it unoccupied as well.

"Guys?"

No answer.

Frowning, April called out again, "Alex? Everything alright?"

Maybe Alex had taken them back to the master bedroom. Moving on to through the empty hall toward bathroom, April grew suspicious when she noticed that the door was half closed, and she could hear the muffled sounds of Adam giggling. She knew she was about to be sneak attacked a split second before it actually happened.

"Get her!" Alex shouted, opening the door all of the way, releasing her two damp, towel wrapped children.

They both sported bath mohawks, courtesy of Dad. Adam and Audrey screeched and ran full tilt into April, snapping wet towels at her legs and reaching up to tickle her.

"Oh no," she laughed, easily subduing one of her attackers by scooping Audrey up onto her hip and getting in a few tickles of her own. "Why do have to get Mommy?"

"A'cause Daddy told us to!" Adam grinned, red faced and barely able to speak over his belly laugh.

April rolled her eyes dramatically in mock frustration, "What am I going to do with you?"

"Whatever," Alex smirked. "You know you love us..."

"This is true."

* * *

_And sometimes, it's truly needed. Fear can be your alarm clock. It can stop you from seeing what's right in front of you. It can spur you to change. So long as you don't ignore it._

"You're not serious," Meredith rolled her eyes at her husband as she pulled the car around a tight corner in Wallingford, searching the block in vain for a parking place.

The neighborhood and the school Zola, Sofia, and Adam attended was exceptionally convenient in terms of coming and going to Seattle Grace Mercy West Hospital, but it's parking lot was way too small to handle the kind of traffic a graduation could bring. Even a kindergarten one.

Derek, in the passenger seat, tilted his head and regarded her calmly, "I'm absolutely serious."

"There's a spot," Zola offered plaintively from the back, pointed to an open space between two cars. Neither adult heard her comment, and the girl looked glumly out the window as they passed an available option.

"You do remember what happened the last time they let us have a clinical trial for Alzheimer's, right?"

He rolled his eyes, "How could I forget?"

During Meredith's fourth year of residency, she and Derek had been testing a new neurological procedure on patients suffering severe and early onset of the disease. The method had shown some promise in maintaining the memory of some patients, but unfortunately Meredith's actions at the time had invalidated the whole thing. She'd made the decision to alter the trial protocol to ensure that Adele Webber got the active medication rather than the placebo. It had cost Derek his trial, Webber his position as chief, and Meredith her job (temporarily).

It had nearly cost Meredith and Derek their daughter.

That was not one of Meredith's career highlights, though she couldn't exactly say she knew what she would change actions, if given the chance. It was  _Adele_.As an attending with years of work under her belt, she liked to think she knew better. But Meredith knew that it certainly wasn't the last point in her career where ethics had gotten murky.

"Mom?" Zola asked from the backseat, pointing to another parking space. "What about there?"

Meredith shook her head, "We'd never get approval. We've been blacklisted."

" _I've_  been black listed," her husband replied confidently. "You were not."

Meredith tilted her head, drumming her fingers on the steering wheel as she pulled the car around the block again for one more pass. Derek did have a point. Rightly or wrongly, he and Richard had done a great job of shielding her from the consequences. In the end she'd gotten her job back, and, though the incident was a part of her permanent record, that failed trial had not prevented Meredith from passing her board exam, obtaining a fellowship, or becoming an attending. A trial under her direction might not be out of the question.

And the idea was really interesting.

"A pace maker for the brain?"

"A device installed just above the hippocampus. Sends small electrical pulse to maintain neural pathways when they are about to collapse. If the pathways don't collapse..."

"The disease doesn't progress. The patient doesn't loose memories."

Meredith had to admit that she liked the simplicity of the idea. If it were ever possible to say that she and her husband had a vendetta with a disease, it had to be Alzheimer's. It had killed her mother, and Adele Webber, and still loomed large as a possible part of her own medical future. If something as simple as a machine could stop the advancement of the disease by reopening degrading pathways. That would be amazing.

"A pacemaker for the brain," she murmured thoughtfully.

Derek crossed his arms and smirked, knowing he'd piqued his wife's interest, "There's already some successful testing conducted in Canada."

Zola groaned loudly, rolling her eyes and throwing herself backwards into her seat, "You missed another spot! We're gonna be late!"

Finally taking notice of her daughter's words, Meredith looked back at the girl through her rear view mirror, "Sorry Zo. We're not going to be late."

"We are," the 9 year old pouted, arms crossed.

Looking back at his daughter and patting her knee gently, Derek continued, "Don't worry. Aunt Lexie and Sofia will save us a seat."

Meredith squinted and turned her head to see the empty street behind them, noting that she had in fact over looked two potential parking opportunities.

"You know what?" she muttered, scanning the empty block quickly for cops and other cars. Meredith had this.

Those spot were still fair game. It's only illegal if you get pulled over, right? Okay maybe it wasn't the best example to set for her daughter, but Zola did have a point. Adam Karev's official exit from kindergarten was less then 15 minutes away, and even if they parked here the walk to the school would talk some time. So, Meredith threw the car into reverse and hit the gas, coasting backwards down the empty street and maneuvering the steering wheel to guide the car into the second space.

"Whoa," Zola excitedly breathed as the car, lurched to a halt.

Meredith threw the SUV into park and glanced back as her daughter unbuckled, "See? We're not going to be late."

The family quickly clamored out of the car and began to make their way up the sidewalk. Derek grabbed hold of their daughters hand and turned back to his wife with a twinkle in his eye.

"Legendary surgeon Ellis Grey died of Alzheimer's, wouldn't it be nice if history says her daughter cured it?"

Meredith rolled her eyes. Her husband was being grandiose. Again. it wasn't an infrequent occurrence. But, sometimes his arrogance wasn't completely unfounded.

"Think about it Meredith..."

She tiled her head to one side, unable to deny or halt the wheels already spinning in her head. It might be possible.

A pacemaker for the brain. It might be extraordinary.

* * *

Alex swallowed hard and leaned forward in his seat, straining to get a better view of his son on the small elementary school stage. Adam was so proud, sitting up ramrod straight in his chair, and bouncing his hands excitedly in his lap. He sat quietly with his classmates, listening to their teacher drone on about whatever kind of crap you talked about at a kindergarten graduation.

More patience and poise than Alex had possessed at the same age. He'd never been good at sitting still in one place as a child.

The teacher was droning on and on about new beginnings and bright futures, and whatever. Alex couldn't really imagine what the hell else the teachers could really say. The kids were 6. What other possible hopes you the teacher talk about, really? Certainly everyone who'd gathered in the tiny elementary school's auditorium to watch the little guys get their mini diplomas wanted nothing more than bright futures and new beginnings for the tykes on stage.

Alex really didn't get all the big fuss about kindergarten graduation crap in general.

But he did appreciate the show of support for his son from his friends and coworkers. The Seattle Grace crew took up a neat little row of seats, and most of the people that mattered the most to Alex (and to Adam) had made it to the ceremony. Lexie and Robbins were there with Sofia and baby Ellie, while their spouses were stuck working at the hospital. Near them, sat Cristina and Jackson also both solo, with their better halves also still at Seattle Grace. On the other side of the long row sat Meredith, Derek, and Zola.

All here for Adam.

By his side, April watched with wide eyes, and Alex could just tell that his wife was doing her best not to cry. He smirked, and noted that to her left his older son Kyle sported a similar wide eyed expression, for completely different reasons. The boy held back a yawn as the teacher continued speaking. And Kyle wasn't the only child of his to be bored by the whole situation. Audrey had dozed off in his lap long time ago.

Kyle and Audrey were more recognizably siblings than either of the children were with Adam. They both had inherited Alex's more olive skin tone, as well as the oval Karev face shape. Adam's paler skin always warranted a generous supply of sunscreen on bright days, and his round face favored Kepner traits. Alex just figured it was part of the DNA deal. Kyle and Audrey also had similar, occasionally grumpy temperaments that were drastically different from Adam's generally cheery and sometimes weepy demeanor. All three children sported the trademark Karev scowl, which, as Alex could see before him, became more pronounced in sleep.

Amber said it was the unified Karev trait, and joked that there was probably a picture of scowling 19th century Karev peasants buried somewhere deep with in the Hermitage Museum.

Gently rubbing Audrey's back, Alex swallowed hard as the speaker began to recite the names of the students, calling them to walk across the stage to much applause from the audience. Finally this show was getting a move on. Anticipation was a bitch. He couldn't wait to get out of the crowded auditorium. He couldn't wait to take his son out for a dinner treat.

Alex couldn't wait to see Adam graduate kindergarten.

"Kaylan Ames." Kid hopped down and grabbed the tiny freaking diploma. Teacher moved the tassel. Applause.

"Robbie Barmore." Kid hopped down and grabbed the tiny freaking moved the tassel. Applause.

"Veronica Beryva."

Rinse and repeat. Rinse and repeat. Rinse and repeat.

Alex smiled as he watched all of his son's classmates made their way across the stage, grabbing the documents that propelled them into the 'real' and challenging world of first grade. As the names inched ever closer to Adam's, April reached over and squeezed his arm. He could tell that she was doing her best not to cry. He could hardly blame her. Time really did fly. It seemed like only yesterday when they were bringing home Adam from the hospital.

"Almost him," Alex whispered with a grin, offering her his free hand. April took it immediately and squeezed his fingers in thanks.

She bit her bottom lip and took a deep breath, "Almost."

Their son was positively bouncing with excitement, leaning so far forward in his seat that Alex was afraid Adam was going to fall off of the thing before his name was even called.

Even with all the clapping, Audrey barely stirred and for that Alex was kind of glad. Audrey being asleep was definitely a good thing. She seemed to be trapped in a particularly long case of the terrible twos, and she'd had her share of tantrums at unfortunate times.

Especially because he knew that his daughter would very soon be spending a total of two whole weeks with his in-laws while he and April flew out to Africa to teach on his Malawi Project. Alex freaking loved the small trips he was able to take to teach in Africa. The residents over there were so grateful, and so determined. They never got up to half the ridiculous crap that Alex, Mer, and Cristina did during their intern year. He loved working with a whole set of folks who truly valued the opportunity they had to learn. And Alex knew that his wife could offer a whole other area of expertise to the students.

It was just...she'd never gone over with him before. Both Alex and April had never been away from their children for such a long time.

He knew they were good caretakers, April's parents. Karen and Joe had turned out to be the best grandparents Alex could ever have hoped for, even if he thought they were a little old fashioned and weird. They treated him like a son, and Alex didn't quite know how to respond to that sometimes.

It made him think about his own parents. His mom and Aaron's medical bills and care and everything else. All that crap he'd learned to cope with in life. Alex certain that April's parents would take excellent care or Adam and Audrey. The niggling concern in the back of his head was about Audrey. She was a great little kid. In a lot of ways she was far less trouble and far less baffling to Alex than Adam could be. And his relationship with her was far less fought with guilt over finding quality time than it was with Kyle, since he went to school and spent most of the time with his other Izzie in Tacoma.

Relating to his sons was sometimes difficult for Alex. But Audrey was his girl. She was the one he  _got._

And yet...well, Alex could only hope that she'd overdrawn her monthly tantrum quota.

"Adam Karev."

The whole row erupted in raucous cheering and applause. No one clapped louder than Alex. He swelled with pride as he watched his little boy hop out of his chair, and all but strutted across the stage to get his diploma.

And he was still strutting 20 minutes later, after the ceremony, as he walked up and down the row of Seattle Grace personnel showing off his diploma. Alex chuckled as he watched April struggle in vain to get the boy to stand still for photographs.

"Look, Uncle Jackson!" Adam boasted, puffing his chest out, and moving just as April held up her phone for a picture.

"Nice."

A smile played at the plastic surgeon's lips as he regarded his godson, resting steadying pretty boy hands on the child's shoulders, keeping him still long enough for April to get her picture.

Adam clutched his diploma so tightly that the paper wrinkled. As though it was the freaking bible. Alex thought it was kind of hilarious how proud of the credential the boy was, considering that the diploma had Sam the Spelling Worm on it. To him it was as official as either of his parents medical degrees. But at the same time, Alex was happy that he was raising a son who could be proud of his own accomplishments, without any fear of self sabotage or second guessing. He could only hope the boy never lost that as he grew up.

Arizona smiled kindly and patted the top of Adam's head, "Very impressive."

"You should get it framed," Cristina deadpanned, making all the adults chuckle.

Audrey was awake and fussy. The commotion in the room increased, as all the families were on their feet and enduring similar displays from their newly graduated kids. She twisted in Alex's arms and began hitting his shoulders.

"Shh...it's okay. What's wrong?" April whispered, turning back to them in concerned as their friends continued to talk to Adam. Audrey only whined and turned her head away from her mother. "Alex I can take her if you want-"

"Nah," he shook his head, lowering his daughter so she stood in his empty seat. "It's fine. She's probably just bored or whatever..."

Alex could understand that. Heck, he'd probably be bored too if he wasn't at a ceremony for his own kid. And Audrey just woken up. He cast around for something that might distract the toddler.

"I'm a first grader now!" Adam continued, looking to his older brother and friends eagerly.

Both Zola and Sofia congratulated him, but Kyle huffed and corrected his brother, "Not until the first day of school..."

"Well, he's definitely not a kindergarten kid anymore, dude. So, he can say he's a first grader this summer. For practice," Alex bargained, reaching down to Adam's discarded cap on the chair behind him, and offering it to Audrey to investigate. Her cries quieted, and she seemed interested, taking the mortarboard in her hands, before curiously placing the object on her head.

"Ha-t," she murmured. "Hat."

And Alex thought it was all cool then. Arguments between his sons averted, and daughter occupied. He shifted his attention, and started talking to Mer and Cristina. He exchanged a good matured high five with Adam, made fun of Avery's longer than normal hair, and wrapped a loving arm around his wife's waist.

He'd thought it was cool. That everything was fine. They all had.

Until Audrey started to scream.

It wasn't one of those normal whining cries toddlers made a fine art. This scream had another dimension, more shrill, more ear splitting, and more visceral than run of the mill shouts. This had the makings of a full blown tantrum. The graduation cap was still on her head, and the tassel had fallen onto the girl's face. She thrashed her arms in all directions, and threw herself on the the row of empty seats.

His friend's all coughed and awkwardly tried to ignore the scene in front of them, while the children in the group covered their ears. Adam flushed with embarrassment, while Robbins's brow furrowed, and Alex had to look away. It always kind of sucked when your kid misbehaved in public.

April turned around first, immediately but awkwardly lowering herself to Audrey's level, "Audrey? Honey, I know you're bored, but we're going to leave soon, okay."

Alex frowned as he watched his daughter flop backwards again as she continued to scream. The sound shifted again, this time laced with panic instead of frustration. She resisted her mother's attempts to restrain her, and lifted her tiny hands to her face, frantically assaulting the hat and tassel on her head. It was stuck on her hair clips, but Audrey refused to stay still long enough for April to remove the hat.

He felt his stomach drop. The sight was eerily familiar. It was stirring up memories Alex had long tried to bury.

Another state. Another ceremony. Another time. Wrestling junior league championships. His mother pulling huge clumps of her hair out while she screamed in imagined fear of her husband. The room full of prying eyes.

Memories no one knew about. No one around here anyway. Not Mer. Not Dr. Wyatt. Not even April.

Audrey continued to scream, twisting further away from April and scratching at her face wildly. Alex could tell his wife was getting worked up too. They'd experienced tantrums before, but this was something else. Their daughter desperately tried to remove her brother's graduation cap from her head, dragging the blunt nails Alex had clipped that morning for her bath down her chubby cheeks, deep enough to draw blood.

Shit.

Alex felt his heart thudding in his chest as the situation escalated. Now, more people than their own group had noticed the bizarre outburst. Whispers and stares cut across the room from other families. Some creeps even pointed.

Everyone was looking at her. Everyone was looking at them.

Alex couldn't stand it. He had better joints than April and easily surprised both her and Audrey when he leaned in and gathered the still thrashing child from the seats. He had to get her outta there. He had to get out of there.

"I've got this," was the only explanation he gave before he hastily made his way out of the school auditorium, down a long hallway, and into the sunny weather out side. He cradled his little girl, removing the stupid graduation hat and letting it drop from his fingers somewhere between the front door of the school and his car.

April kept first aid kits in both their cars, not to mention in a dozen other random places around the house and in the garage. Thank goodness it was there today.

Without the hat, Audrey sniffled and took shaky breaths as she tried to calm down. Alex had to focus on his own breathing as he carefully cleaned the small red gash that now occupied his daughters cheek.

"Oh, Aud," he mumbled, gently applying antiseptic cream to the wound.

It was calm outside and few people passed my on the street. Alex could hear the sounds of birds chirping faintly beyond the thud of his own racing pulse in the back of his ears. They'd had such a happy morning too. And the ceremony had gone well. Things had been fine. Alex didn't want to believe what he was seeing in front of him.

"Oh, Aud," he repeated, unwrapping a pink and green striped band aid from the car kit. "You can't be pulling crap like this...trust me, you gotta grow out of crap like this..."

Because, while crap like this seemed to be pretty bad for a 3 year old, Alex knew that it was exponentially worse if someone continued to do it at 6, 12, 18 and beyond. He knew the signs. He grew up with the signs. But Alex just couldn't allow himself to add up the signs he saw in his daughter. He just couldn't face it.

Alex felt like he'd break if he faced it.

Surely it wasn't the same.  _Surely._ She'd grow out of it. 3 year olds have tantrums all the time. Bother her brothers had. Zola and Sofia too. This would pass. It would disappear as she got older. Right?

Audrey looked up at him tragically, with her lower lip jutted out in a deep pout. She ran her fingers rhythmically along the plastic arm wrests of the car seat as he placed the bandage on her cheek smoothing out the edges. He cupped her cheek, smiling sadly, and brushing away her tears. Alex knew she couldn't really even understand him. And if his deepest unspoken fears were really true, he also knew that she couldn't really help it.

"Oh, Aud."

  
_So really what we should say about fear isn't get over it. We should say get through it. Because the feeling is real. We're all afraid. And that's okay._ _Being afraid means you have something to lose. It means you are alive._

 


	2. Chapter 2

April chuckled as she watched her son carefully step down the stairs, arms laden with what looked like most of his toy box. Shaking her head, she folded another tiny pair of shorts and laid them neatly into a suitcase, exchanging an exasperated glance with Jackson as he helped her pack an Africa box. Adam scowled in concentration, and stuck out his tongue as he navigated his way to his mother's side in the living room.

Shaking her head at the boy, April said, "I told you that you could pick five. You can't take all of those toys with you to the farm, kiddo."

"Yes I can!"

"No, you can't," she gestured at his suitcase. "You don't have the room. Besides, Grandma and Grandpa have a bunch of toys at their house."

Adam scowled, "A bunch of old girl toys."

Jackson snorted and April shook her head. She could concede that Adam kind of had a point. He (and to a lesser extent his brother Kyle) were the only young boys in the family. All of her sisters children were girls and they all lived close enough to her parents that it was their dolls, tea sets, and toy ponies that were left behind at the farm, along with even older stuff left behind from when April was growing up.

Still, she didn't want Adam and Audrey to feel confined by gender stereotypes. They both had toys in their rooms that were more typically marketed to the opposite sex. So April shook her head.

"There's no such thing as girl toys and boy toys. A toy is a toy. Anyone can play with whatever toys they like."

"Well," Adam grinned, sweetly using all the charms he knew he had to try and exact his desires. "I know that...I just like these ones, Mama."

Beside her, Audrey hummed quietly and drummed her hands on the coffee table as she watched her brother struggle not to drop one of his precious trucks. Glancing up at April, the girl nodded and said quietly, "Too too much."

Adam lost his grip on his toys, sending a truck, Woody, 2 ninja turtles, and a stuffed rabbit cascading to the floor.

April tilted her head and looked at her son firmly, "See? I told you; only pick five."

Jackson chuckled and knelt down to help his godson collect his prized possessions. He'd come over to help Alex and April finish packing themselves and the children for their respective trips. In less than 24 hours, both children would be in Ohio with April's parents, while she and her husband would be somewhere in the middle of a transatlantic flight to Africa. And yet, they still were not fully packed.

April was getting a little frantic. The type A planner control freak within was not happy with the progress of the packing. Ideally, she would have had this finished days ago. But between Adam's graduation, unexpected surgeries, and conflicting work schedules, packing had been pushed to the back burner. In the past day and a half, April and Alex (with generous help from Meredith, Arizona, and now Jackson) they were almost done.

Thank goodness for old friends.

"You know," Jackson told Adam affectionately. "If you go to Ohio without your toys, I bet you could convince your Grandpa and Grandma to buy you some new ones..."

"Jackson! Don't tell him that!" April chastised.

Alex stalked downstairs dragging a large suitcase (which April suspected was probably over packed) behind him, reaching the first floor with a loud thud. It made all of them jump in surprise, but the noise made Audrey stiffen and flap her hands nervously.

"Daddy," April called to her husband, in the voice she used when talking to Alex on the children's behalf . She knew it annoyed him to no end. "That's too loud."

She lifted her whining daughter to her hip and rubbed the girl's back soothingly. Audrey's outburst at Adam's graduation was the worst she'd ever seen, but admittedly it was far from the only one. When you really stopped and thought about it, little incidences had been cropping up for months. It worried her that she would be separate from the child for two whole weeks so soon afterward.

Alex said it was just a long case of terrible twos. Her parents said that the youngest child always seemed to cause more trouble just because there was already so much other stuff going on. Callie and Arizona said a diet change that limited sugar had made a world of difference for Sofia at the same age. April didn't know what to think really. Her internet research yielded little information either. Only things that worried her.

Sometimes, Audrey seemed perfectly normal. A bit eccentric about certain things, yes. She didn't like hats, eating vegetables, or lacy dresses, but what toddler did?

On a whole Audrey was normal.

Right?

Other times Audrey startled. Or had weird fascination with watching things or touching things. Just this morning, April had watched the little girl's apparent enthrallment with running her hands across the top of Jackson's newly shaved head.

Things like that were enough to send April's worries running in circles around her mind.

"Too loud? You gotta get used to some loud. On the farm there's gonna be big loud pigs making noises all the time," Alex swooped into the living room and took Audrey from April's arms, making the girl giggle.

"Fortunately, she's had plenty practice living with a pig," Jackson quipped.

"Hey!" Alex countered with a sheepish smirk, leaning to his daughter's ear and offering a dramatic snort. "Oink, oink!"

And just like that, the potential crisis was averted. April could almost sigh in relief. Audrey was back in good spirits and Adam was laughing hard too. Alex always knew just what to do, whether from innate instinct or pediatric background, and for that April was grateful.

Nudging his shoulder gently, April asked, "All done?"

When it became apparent just how far behind they where in packing, she'd given him a list.

Rolling his eyes, Alex pulled the list from his back pocket. "Yeah, yeah, yeah. All done except for one thing."

Squinting at the list, April scowled in confusion. He'd crossed everything off. "Did you pack the extra gauze?"

"Yup."

"Extra sunscreen?"

"For you."

"Enough clothes?" He always seem to under pack pants.

"Heck yeah."

"Then what is the last thing?" April asked incredulously.

Alex grinned, "One last trip to Molly Moon's with the midgets to tide us over until we all get back home."

Adam started jumping up and down, "Yeah! Yeah! Can we pwease? I want ice cream!"

It was a ritual of Alex's. He loved taking the kids to get treats at the local creamery after his shift ended at work, even before dinner. Then all three of them usually came home with full stomachs and a sugar high, but the scene was always much too sweet for April to veto. In the same way her special rituals with the kids involved reading books to them, Alex's tended to involve food. She knew that it was extra important to her husband to spend time doing things (anything really) with the kids. Alex's own father had abandoned his family after years of abuse, and it was something April knew he was desperate not to repeat with his own children.

Though she'd never met her father in law, April had no fear that Alex Karev was anything like him. But she knew Alex worried.

She smiled at her son, "Why don't you and Aud go with Daddy, while Uncle Jackson and I finish packing your bag?"

"Okay!" Adam clapped his hands and walked alongside Alex toward the front door.

"You guys want anything?" Alex called back into the living room.

Jackson shook his head and April replied, "We're good, thanks."

"See you in a bit."

"Daddy?" Adam's voice rang out just before the door shut behind them. "Will you say hi to Simba in Africa for me?"

April leaned forward and unzipped the bag that her husband had packed, mentally checking off what exactly on her list Alex had packed, causing her best friend to chuckle, "You double checking his work?"

She made a face. "Maybe."

It wasn't that April didn't trust her husband...well, she trusted him for many things. But perhaps for some things, she didn't.

"I just want to be sure."

"Right."

It was nice to hear a genuine laugh out of Jackson. Lately the circumstance seemed rare. He'd put on a good show for the children, but the plastic surgeon had been subdued the whole day. And April knew why. As much as she had her own problems, she knew her family was not the only one with unanswered questions. Jackson and Mara were in a tough spot.

Peering into Alex's over packed suitcase, April probed, "So, um...how are things going this cycle? How is Mara feeling?"

She winced when she saw the scowl appear on her best friend's face. Jackson wasn't exactly the kind of person who easily shared his feelings. He was the guy who was there for other people. The friend, the protector, the problem solver. Even though they'd been best friends for years, April knew that Jackson tended to keep his worries to himself.

Especially when it came to his and Mara's continued infertility.

Her friends had been trying to get pregnant since before Audrey was born, and April knew that on some level, Jackson and Mara likely resented that Alex and April were able to expand their family fairly easily. She remembered the conversations from around that time well. Both couples had made the decision to grow their families at about the same time. But quickly all dreams of having children born close together vanished.

Jackson frowned, "See, why do you always have to do this? We're having a nice fun moment and then, BAM: 'Tell me all your problems'."

Clearly she'd hit a nerve.

"I was just-"

"Asking me about stuff I don't wanna talk about. Well, I can play that game too," Jackson snapped, holding up a small sundress to fold. "Have you figured out what's up with Audrey?"

April swallowed hard and bit her lip, trying to keep her voice from wavering. Jackson knew how to hit nerves himself. "Well...we're not sure anything is really 'up' yet. I-I hope it is just a phase."

She must not have done a good job hiding her emotions because Jackson immediately looked apologetic. He hung his head and folded Audrey's little outfit before cramming it into her tiny suitcase and zipping it shut. He sighed and rested his hands on top of the small suitcase, collecting his thoughts.

"I'm sorry. I didn't-I didn't mean to say that."

"You're probably right though," April conceded. "I do tend to pry...and...I am worried about Audrey. Alex acts like I am just overreacting...When we come back, I think I'm going to have to make Alex see what I see."

"This round of IVF didn't take either. Just like the last three," he admitted dejectedly. "We only ever got pregnant the one time and that didn't even last 11 weeks."

She nodded sympathetically, "I'm so sorry, Jackson."

"And Mara...she doesn't...she just turns around and says she wants to give it another go, you know?" Jackson shrugged. "She acts like it's not killing her. Stiff upper lip and all that. Doesn't want to talk about other options. But I can see what it does to her...and I can't fix it."

"Your doctors still don't know the underlying cause?"

"They say I'm healthy and she's healthy. Our infertility is 'unexplained'. We're coming up on four years and nothing. I don't think even Dr. Kental knows what the problem is." He laughed humorlessly, "It's ridiculous. It took me so long to figure out if I even wanted to have kids, and now that I do, I can't have one."

"Oh, Jackson..."

There really wasn't anything April could say to make things better for her friends. It was a pain she couldn't even fully understand, since she'd never experienced it. All she could do was be there for them she supposed. And even that didn't seem to be enough.

"Maybe it's for the best anyway. Avery's don't exactly have the best track record with fatherhood anyway. I doubt I would be much better..."

"Don't say that," April said, closing the suitcase in front of her and moving to Jackson's side. "You are going to be an amazing father. Someday. It will work out. I know it."

Jackson smirked, "Thanks for saying that."

"It's true. You're already Adam's favorite godfather..."

"I'm his only godfather."

She nudged his shoulder playfully, "See? You'll be your kid's only father too. They'll have to love you."

That garnered another burst of laughter and a real smile. Her friend grabbed hold of April's hand, "I know it's only two weeks, but I am really going to miss you, April."

April sat up straight and raised her eyebrows, "Ha! Remember that the next time you think I am being too nosy."

"One second thought-" Jackson joked.

"Shut up!"

* * *

 

Rushing through the crowded hallways of Seattle Grace Mercy West, Meredith tried to scan the file in front of her and listen to the hurried speech patterns of her resident. She'd been spending more and more time in the research library, trying to investigate whether or not's Derek's idea for a clinical trial on a brain pace maker. If there was any chance of getting funding for a clinical trial, Meredith knew she had to understand the ins and out of all previous work done on the idea. She needed to become an expert. The research she'd found from Canada looked promising, and for the past several days Meredith had been more than content to allow her advanced residents and fellows to handle new neuro cases and consults.

That is except in cases where her resident's were in over their heads. Way over their heads.

"Dr. Robbins wants us to go for the least invasive approach," Dr. Levette concluded breathlessly. "She's been working with this kid since she was like 4 months old apparently, and the bleeder isn't that big- ."

Meredith held up a hand as they hurriedly entered the scrub room and began to wash her hands, "Well, we'll just have to see what is going on. I can't make any promises. And neither should you."

The young doctor swallowed hard, and blinked rapidly as they burst through the OR doors. "Right..."

"Oh look," Arizona said brightly as Meredith and Levette quickly moved to the head of the patient. "How wonderful of you to join us, Dr. Grey."

Ignoring the strange tone of her friend, Meredith began examining the young girl in front of her. "What have we got?"

"Routine adenoid removal. Some blood showed up in our tap," Robbins explained. "Levette thinks it is a frontal bleed, but there isn't very much flow."

Meredith frowned, taking in the slow and steady red drip on the monitor. All the signs indicated that it was a frontal bleed, which was actually a pretty routine risk for this kind of procedure. However, the bleeds, especially in children were usually quite extensive. This seemed to be no more than a trickle.

That was unusual.

"It isn't a typical presentation," she agreed. "Dr. Levette set me up well for a simple patch."

"Which is good considering how long it took you as the consult to get here," Robbins replied perkily, continuing her work.

Meredith groaned as she set to her task. Her friends were so far from subtle, it wasn't even funny. "Do you have a problem, Dr. Robbins?"

"Only when I think that my tiny human patients have to wait too long for a potentially life saving surgical consult."

Dr. Levette cleared her throat and ducked her head after exchanging a surprised glance with the scrub nurse. It was rare that attendings called each other out so clearly, even though there was well known and fierce competition between the specialties. Every surgeon thought that their work was the most important.

"I came as soon as I could," Meredith replied as she began to expose the small patient's brain.

"From the research library," Arizona quipped. "Not from dealing with other patients or finishing up another surgery, but from the research library."

"I'm allowed to do research. I want to plan a clinical trial."

The blond rolled her eyes, "Newsflash! We all do research, Dr. Grey. Every attending in this hospital wants to plan a damned clinical trial. That doesn't mean we skimp off on our consult or teaching requirements. It also doesn't mean we forget to pick up our child from a sleepover...twice."

That was probably the real heart of the pediatric surgeon's anger. A simple mistake.

"I thought Derek was getting her," Meredith explained quickly. "Not all of us are lucky enough to have essentially 4 people on beck and call to take care of their daughter. You and Callie have Mark and Lexie too. Derek and I are just us. We totally owe you one. Besides, Zola and Sofia had a great time. It's summer; two nights with your best friend is a total treat."

Zola had seemed thrilled.

That didn't mean she didn't feel bad about the whole situation though. Her husband had been stuck in surgery for 16 hours with a particularly stubborn aneurysm, and Meredith had gotten a little lost in her research. Time got away from her, and by the time she'd checked her pages, there was no one left available and not working to pick Zo up. Normally, Meredith would have turned to Alex or April, but they were busy with the first leg of their Malawi trip. They were barely gone from the hospital and Meredith could already feel their absence, from the loss of shared childcare alone.

"Look, I know I've gotten a little wrapped up in my work lately," she continued. "I know I need to get better at balancing things out. I can handle it. I just...I think I am on to something really important."

"Maybe so," Arizona agreed. "Just remember that helping your residents learn to treat actual patients is really important too."

Meredith nodded and glanced over to Dr. Levette sympathetically. Capable or not, she knew that the woman was only a third year, and thinking back to her own residency, she couldn't say that she was offering Levette the same level of teaching that she'd received as a student. Granted, she'd been romantically involved with her neoro teacher back then, so time spent one on one had a completely different meaning, but it was still clear that her sudden interest and focus in coming up with a clinical trial was taking her attention away from other responsibilities.

Normally, Meredith knew how to balance all the aspects of her professional and personal lives. But this? This was Alzheimer's. A potential cure for the disease that seemed to be her arch nemesis. Meredith wanted to beat it. No, she needed to beat it.

It was hard not to get carried away.

They all worked in silence for several minutes.

"You know," Meredith said finally, hoping to clear the air. "I used to never believe Alex when he said you could be a real hard ass. You don't really give off that impression."

She could tell Arizona was smiling behind her mask, "It's the heelys."

"Ah."

"I am just passionate about advocating for my patients. I expect you to do the same to me when the situation is reversed. And that will happen at some point. I've go a few research ideas of my own."

"Got it. Will do," Meredith agreed.

"Speaking of Alex," Arizona continued, glancing over at the big clock on the far wall of the OR. "I bet he and April have almost arrived in Malawi by now."

"Probably."

The Africa Project was one of Dr. Robbins crowning achievements as the head of pediatric surgery at Seattle Grace Mercy West. It was near and dear to both Arizona's and Alex's hearts. Between the two of them, along with the help of Dr. Lucy Fields on the ground, they'd built a a formidable charity and educational center in Malawi's capital. Meredith also knew that it was one of the ways that her friend and his mentor had bonded and proved to be an excellent team.

Meredith knew that Alex took immense pride in the success of the Africa Project. Back in residency, he'd really only gotten in on the project as a part of his bid for being chief resident, but now it was the biggest achievement in his career, and Meredith knew that he was dedicated to ensuring that the teaching program made a real difference. The work had gone a long way in bolstering her friend's occasionally shaky confidence.

"Dr. Fields is so pleased that Kepner decided to come on this trip; they've been in such need of trauma education," Arizona commented.

"I can understand why she's been hesitant to go though," Meredith replied. "Malawi doesn't exactly scream handicap friendly..."

April's leg hadn't been the same since it was crushed in an earthquake nearly 8 years past. Metal plates, rods, pins and some skilled work by Dr. Callie Torres left the trauma surgeon with pretty decent use of her right leg. She had a limp, occasionally used a cane and certainly wouldn't be running a marathon anytime soon. Which was fine for Seattle. Not really even a big deal these days.

But Africa was a whole different ball game. Meredith could understand why April had initially been reluctant to visit.

Dr. Robbins tilted her head to one side, "That's probably one reason...there are other factors to consider too."

"Leaving the kids?"

"Well," Arizona said cryptically. "The vast majority of the surgeons who have participated in this project have families. I just think for Alex and April it's..."

Meredith bit her lip behind her mask and carefully made the finishing touches to her work, "It's different."

"Audrey can be a handful and a half sometimes."

That was certainly one way to put it. Meredith loved and was very close to her godchildren. Adam and Audrey were very important to her. So was Kyle Stevens. To all of the hospital family really. They all cared about each other and everyone's children. Zola and Sofia, and Tuck and little Ellie along with Alex and April's children had plenty of people to love them, no doubt about that.

And all the kids had their ups and downs. But if Meredith was honest, she could admit that there was something different about Audrey. The girl was still young, and often as sweet as can be. But when she acted out, she acted out. Not in the normal kind of toddler tantrums.

Audrey's favorite word wasn't no. She didn't bite other kids when she was angry. She didn't draw on walls. Alex's daughter flipped out for seemingly no reason at all.

"She can be, yes," Meredith agreed.

Given what Meredith knew about the Karev family mental health history, it was enough to raise her suspicions. Not that she'd say anything to Alex about it, of course. That would be a fast track to the silent treatment. They'd come a long way and gotten very close as friends over the past few years, but Meredith knew that the one thing Alex still hated to discuss was his family's 'crazy'. And talking to April about it was bound to cause a panic attack.

It was probably all for nothing anyway. Audrey was still very young. And her parents had big and occasionally difficult personalities of their own. Odd behavior didn't automatically mean something was actually wrong.

"But she's 3. Remember 3? They're all insane at that age."

"I'm done here; I'm closing up," Arizona said, leaning forward to finish a fine row of stitches on their tiny patient, who wasn't much old her than Audrey. "I know that toddlers are a beast of their own, but Audrey..."

The pediatric surgeon paused, looking to the ceiling as though she was carefully considering her next words.

"I wonder about her."

Meredith was apparently not alone in having unspoken worries about her friend's little girl. His mentor, with her years of experience in pediatric surgery had concerns as well. And somehow Arizona saying so out loud felt like a release to Meredith. Her reservations, hesitations, and even the context of the OR all seemed to fade away. Though she and Robbins had started off their procedure disagreeing with each other, Meredith felt a certain solidarity of sentiment when it came to their worries over Audrey Karev.

Meredith met Arizona's gaze. "I do too."

* * *

 

Alex winced and plugged his nose, holding his breath as the plane sailed down into a slightly lower altitude. Next to him, April shifted, stretching her bad leg painfully into the aisle. They were making their final descent into Lilongwe after what seemed like an herculean journey. And really when you thought about it, 33 hours was pretty freaking epic.

They'd started out with Adam and Audrey on a flight from Seattle to Cleveland. Alex had made sure to sit with his daughter on the plane ride because he'd been certain that she'd have a tantrum or start crying or whatever and much as his wife might hate to admit it, he was slightly better at handling the girl when she had her moments. But it had turned out to be a moot point. Instead, he and Audrey colored quietly, while April dealt with the madness of Adam Percy Karev on a plane.

Maybe that was a bit of an exaggeration, but Adam wasn't usually like this. For most of the flight Alex could admit to himself he was glad to be seated in the relative quiet of the other side of the aisle.

First the boy couldn't get his ears to pop. So he whined. Next, Adam fussed over not having a better view out of his window once the plane had ascended above the clouds. So he fidgeted. After that, the six year old couldn't get comfortable. So he'd kicked. Then he was thirsty. But he didn't want any of the juice available to him on the plane. So he'd cried.

Each outburst of course was skillfully handled by April. She was a master of distraction, despite the physical discomfort she always felt when riding on a plane. Before they'd had kids, Alex had had no idea just how great a mother he'd find his wife to be. Maybe it was because he'd spent so much of his own childhood taking care of his own mom instead of the other way around. But watching April with their children (even when she was almost to her wits end with their antics) always kind of did something for Alex deep inside.

He felt lucky.

Adam's ears wouldn't pop? April was prepared with strawberry Bubbleyum in her purse. Adam didn't think the clouds outside his window were interesting? April challenged the boy to imagine what animals and people he could see in their shapes. She scolded him when he kicked. She'd even mixed together a concoction of her own juice and ginger ale to see if that taste would suffice in an effort to stop his tears.

All freaking amazing.

He'd said as much to Audrey as they watched Adam's tears die down after the juice issue. "Your mom is the best, huh kiddo?"

Audrey didn't lift her eyes from the scribbly red circles she was drawing in her coloring book, but after a moment she'd basically agreed. "Mama nice."

Couldn't really argue with that.

By the time they'd reached the Cleveland airport, it was becoming crystal clear to Adam that he was not going to see his parents for a very long time. And for the first time, that seemed like it was scary to the boy. He clung to April's hand like a lifeline and initially refused to let go, even after they'd met up with April's parents in the main airport lobby.

Which Alex could tell was hard on his wife, which in turn fed a tension in Audrey who watched her mother intently and clung to his shoulder as he carried her through the crowd. Joe was easy to spot in the sea of people, and both children adored the man, but even when Alex pointed him out, none of his family members displayed none of their usual enthusiasm upon seeing him.

There hadn't been much time really, to do hand off, so Alex quickly wheeled his daughter's tiny pink suitcase over to her grandmother and carefully transferred Audrey to Karen's open arms.

"What happened here?" Karen had asked, immediately taking notice of the healing scratch on her granddaughter's cheek.

"She scratched herself," April explained sadly, slipping the handles of Adam's suitcase into her father's hands after kissing his cheek. "I told you she had a little incident at Adam's graduation..."

While April tried to coax Adam into letting his vice grip release her hand, Joe and Karen chatted hurriedly with their daughter. Alex participated half only heartedly. His focus was on Audrey. He could tell by her breathing and the way her head kept swerving from side to side that she was probably getting a little over stimulated. She'd given no real reaction to seeing or being handed over to her grandparents, and it looked like she was once again retreating to her own little world.

Alex had hoped that Audrey was only reacting to the airport. He gently stroked her cheek, trying to pull her attention to him, "You be good okay? Be a good girl."

When she didn't respond, he leaned to her and added in whisper, "Keep it together, huh? I know you can do it."

The touch and whisper seemed to work, because Audrey made eye contact with Alex, nodding slowly and slipping her thumb into her mouth. She seemed resigned to the goodbye and comfortable in the arms of her grandmother. Adam however, was a different story. He was starting to cry and that in turn was making April choke up.

Alex turned to watch as his wife and his father in law, continued to work on convincing the boy to willingly separate from his parents.

"You know what, Adam?" Joe said cheerfully, bending over to smile at his grandson. "We've got a brand knew baby calf on the farm. Doesn't even have a name yet. I thought I'd leave that for you to do. What do you think about that?"

Adam only pouted and shrugged, "I don't know."

"That's fun, right?" April said, clearing her throat and trying to sound happy.

Alex stuck his hands in his pockets and moved to stand next to his son, "Freaking cool. Not everybody gets to do that."

For whatever reason, that seemed to break a damn in Adam. His face crumpled, and he started to sob, wrapping his arms firmly around April's good leg. "Take me wif you! Pwease! I don't wanna go there. I wanna stay with you!"

Crap. Alex hated it when his son cried. April early did too. He thanked his lucky stars that Audrey wasn't crying too. His wife wouldn't have been able to handle that. He'd glanced at a large clock on the wall, and noted that their time to catch their next flight was short. As hard as it was, Alex knew that they had to wrap things up.

"Okay...we gotta do this..." He bent over and pried Adam away from his April's leg, passing him over to the strong arms of Joe Kepner. The boy struggled, but it wasn't like he could get away.

Alex had squeezed his son's shoulder, "It'll be okay."

"We'll see you both again soon, honey. I promise," April blubbered. "Remember number of days are only two hands and for toes. You'll have a good time and be home before you know it."

Before the situation escalated even more, and before they ran out of time to make it back through security and on to their next fight, Alex and April both kissed both children quickly, offering their love and goodbyes. Not that it had made that much of a difference. Adam's crying could be heard all down the hallway, and April had wiped tears from her cheeks as they waited in line for the TSA check at the international gate.

"I just...I feel so bad leaving them."

Alex held her hand and hung his head. The feeling did suck. But it wasn't like it wasn't for a good cause. Teaching the student doctors in Africa, even for only two weeks, would definitely make a difference in countless lives. Plus, April's parents would get both children to have fun in no time. It was just hard to focus o that when you could still hear your child screaming down the hallway.

And then the real marathon of their journey began. The first leg from Cleveland to Toronto was reasonably easy. Both Alex and April were tired and had slept for that short flight. Toronto to Addis Ababa had been noticeably harder, not because they were any less tired really, but because by that time April's leg was stiff enough that it was hard for her to sleep. And an awake April was a chatty April.

So Alex didn't sleep much either.

Addis Ababa to Lilongwe left the two of them too excited to sleep, but also quite frankly, a little fed up with each other as well. 30 hours was a long ass time. So the bulk of this flight had been spent quietly working on tablets and plans for the respective classes they would each be teaching at the clinic of the University of Malawi.

And now they were on the ground. Freaking finally. Peering out the window as he waited for the plane to clear out, Alex smiled at the familiar landscape that met his eyes. In his years of travelling there he'd grown to love much about the beautiful country. He was excited he to share more than photos with April this time. Now, she'd have the experience and memory of the place too.

"Welcome to Africa."

April followed his gaze and looked at the surrounding of the airport with interest, and answering breathlessly, "Here we go."

He grinned, "You are gonna have a blast."

Once the plane had cleared out, Alex rose from his seat and started to gather their carry one baggage, watching as April continued to sit, wide eyed. She shifted uncomfortably and stared at her right bum leg, spinning her cane in her hands nervously.

"I don't actually know if I can get up."

Alex slung their bags over his shoulders. He walked to April's seat and held out both of his hands, helping his wife to her feet after sitting down for so long. April's metal knee joint shifted position with an audible pop that made her wince as she used her cane to move into the plane aisle.

Following her toward the exit of the plane, Alex did what he could to take April's mind off of her leg. He smirked, playfully grabbing her butt and whispering, "Gotta love my bionic woman."

April giggled and flushed red, as they made their way off of the plane and into the small but bustling Lilongwe Airport, "Shut up."

Getting around and finding baggage claim was relatively easy, since the smaller airport didn't have nearly the volume that major airports in the states managed to sustain. Malawi was also a former British colony, so most of the people and signs they encountered communicated in English as well as Chichewa, the local language.

Alex was just lifting their last (and heaviest) suit case from the conveyor belt, when April grabbed his shoulder and pointed across the room. "I see Dr. Fields."

Lucy Fields wasn't exactly hard to find in a crowd in Lilongwe. She kind of stuck out like a freaking sore thumb. Over the past few years of working in Malawi, Lucy had aged, just like anyone else. But she was still a preppy looking white woman in a third world country. Just like April and Alex were not the typical couple collecting bags in the airport. Fields spotted them just as easily as April spotted her.

"She's coming over," April whispered out of the corner of her mouth, keeping her expression calm as she made eye contact with the blonde surgeon.

"Well, yeah," Alex reasoned. "She's here to pick us up."

Leaning heavily on her cane, April continued to whisper, "She's not going to be micromanaging us, is she? I mean, we won't have to see her all the time, right?"

"Nambose Clinic is not a big place; you'll be seeing her."

April pouted, "You used to date her."

"I know. So what?" Alex shrugged. "I used to date Lexie too, and you see her at work all the time."

"Well, that different. I like Lexie. This is gonna be awkward."

He watched amusement as April plastered on a fake bright smile as Lucy came ever nearer. His wife was jealous.

"I married you, you know," Alex explained under his breath. "You're ten times better than Fields. She stole freaking my job. Total bitch..."

April snorted, and then pulled it together as Lucy greeted them and offered to take one of their suitcases.

"Hi!" The OB/GYN said brightly. "About time you came back, Karev."

He shrugged, "Well, you know how it goes. Had to recover from my last trip."

Fields turned to April and held out a hand, "And it's so nice to finally meet the legendary Dr. Kepner. Your husband speaks very highly of you. I hope his estimation of your trauma methods prove to be true."

April's jaw dropped as she shook the other woman's hand weakly, "We've met before..."

"Oh?"

"I was in the same year of residency as Alex when you were at Seattle Grace Mercy West. We delivered a baby together..."

Lucy's thin and perfectly sculpted eyebrows lifted towards her hair line, "Oh? I don't recall."

It was kind of obvious that she did, and April blinked in shock, while Alex swallowed awkwardly. When Alex had first began his trips to Africa, things had been a bit tense between him and his sort of ex. Lucy had been surprised to find that he'd not only gotten married in her absence from the hospital, but that he was a father too, at the time having both Kyle Stevens and Adam. They weren't exactly close worked on the program, but they'd managed to reach a nice balance to train and mentor students, while managing to have some fun along the way. He'd never seen Field quite like this.

It seemed she was a little jealous too. Great.

Turning and beginning to lead them out of the airport, the blonde added briskly, "You'll want to be really careful when you walk. The pavement is going to be very uneven. We don't want you to need any more trauma assistance yourself. At least not before you've taught your class. I can call for a wheelchair if you like..."

April replied politely, "No, I am fine, thanks."

"If you say so..." Fields said doubtfully.

"I-I-she..." April sputtered angrily in a whisper that only Alex could hear.

"Whatever," he comforted as they followed Fields to the street, unable to quite keep up with her pace. "Ignore it. She's just messing with you."

Scowling his wife set her jaw, and pushed forward, using her cane to carry herself as fast as she could. Alex frowned when he realized that April was trying to catch up with Dr. Fields, even though it clearly hurt her. It was hard for her to resist her competitive streak.

Oh, this was going to be interesting.


	3. Chapter 3

April swallowed hard and watched as her husband and Dr. Porter, another American physician who worked on the program, share a joke with Lucy Fields. Like the other woman was  _so_  funny. April rolled her eyes. Five days in and she was are ready pretty much over the OB/GYN.

 _Way_  over her, in fact.

Personally, April found Lucy Fields to be cold and back handed. Though, she could admit, some of that might stem from a residual jealousy of Lucy's history with her husband. Probably a lot of the dislike stemmed from that past.

It wasn't like she didn't know that Alex had led a full and robust romantic and sexual life before getting together with her.

April knew that. Heck, she dealt with the evidence of that on an almost weekly basis, when she co-parented her stepson Kyle with Alex's ex-wife Izzie. That had been hard at first, but in the end April thought that she'd done a good job of handling all her feelings about her husband's ex-wife. She'd built up a tolerance, if not a friendship with the other woman, and had no problem spending the occasional holiday or birthday with Izzie.

For the kids at least. Kyle, Adam, and Audrey loved each other and acted like it most of the time. So April figured they had to be doing something right.

Lucy Fields had no secret child with Alex, nor did she play nearly as big of a role in April's life as Izzie Stevens. Alex barely saw the woman, only when he made his short trips to Africa, and really even at Nambosi clinic as far as April had seen, the interaction was minimal. He ran classes that had to deal specifically with pediatric cases, while Lucy did a few on obstetrics and gynecology. She'd been in Malawi running the program long enough that she wasn't even the primary teaching OB anymore. Dr. Valero, a kind soft spoken man who April actually liked very much, did the bulk of the actual instructing on the subject done in the program. Fields did a lot of administrative and fundraising work.

So it wasn't like Fields was in April or Alex's face  _all_ the time. She was just around.

But somehow, for some reason, whenever April found herself in the vicinity of the blonde surgeon, she had to resist the urge to punch the smug look of Field's face. Not giving into the impulse was doubly hard whenever Alex was also nearby.

And she knew it was mean and that she wasn't really a violent person  _and_  that the jealousy over Alex was really unfounded, yet April couldn't shake the feelings that rose in her chest when ever she had to interact with Dr. Fields. And it didn't even all relate to her husband, when she really thought about it.

Maybe she was being paranoid, but sometimes it just felt like Lucy didn't treat her with much respect. Something in the way she spoke to April just felt...

She couldn't actually articulate it exactly. But something in the way Lucy treated her didn't make April feel good. It had started right away on that first day in Lilongwe.

The walk from the airport to the car hadn't taken very long, but Lucy acted like it was something that April couldn't handle. How many times had the woman turned back on the way to the car to ask the same damned question?

"Are you sure you don't need me to get you a wheelchair?"

Sure, April was stiff. Yes, she was using her cane. Her limp was much more pronounced than normal due to the length of her flight. But it wasn't like they were trekking across the Himalayas! April had been walking on her bad leg for years at this point, and she knew her limits. Right now she had to walk a little slower, and deal with a little pain, but that was it. April didn't need or want any more attention drawn to the fact that much of her right leg was synthetic.

She knew that already. She was painfully aware. But April didn't need a wheelchair any more than she needed Lucy Fields' constant badgering.

Alex had calmly whispered in April's ear, "Whatever. Just ignore it..."

But even that was hard, because in Malawi it seemed everyone seemed to comment on April's leg and cane. At Nambosi clinic, Fields led them towards their rooms, telling the students who'd assembled out front to help carry bags, "Dr. Kepner will need some help."

Marking April as different.

Within moments she'd heard the whisper go through the small crowd as they tried not to stare.

"She is lame?" One student asked another.

April had scowled. Maybe she was, but not  _that_  kind of lame.

"A cripple."

"Traumatic crusting injury. Near full lower leg replacement, instead of amputation. I read online. Very good work."

"America." They all nodded in awe and murmured in agreement. "Only in America."

Alex had cleared his throat and stared down the whisperers, students he was familiar with apparently, "Simmer down guys. This isn't some freak show. It's no big deal and I don't want to hear you acting like it is."

Chastised, the students nodded and ducked their heads. They respected Alex. Nothing more on the topic of April's leg was mentioned and the group busied themselves gathering luggage.

"I'm sorry, I just gave them all a heads up that she'd need a little accommodation," Lucy explained, feigning apology.

It wasn't like April didn't need help sometimes. But the operative word was  _sometimes._  And more often than not April liked to try to do most things herself before she turned to others for assistance. Because it turned out that more often than not she could do far more than people expected her too. Heck, even being a successful trauma surgeon wasn't something outsiders might think she was capable of.

"When I need it, I'll ask for it," April muttered, watching awkwardly as the students carried her suitcases away.

Field's smile didn't ever seem to reach her eyes. "Just trying to help."

And maybe that was the whole thing really.

April was jealous in one sense of the woman's previous relationship with her husband. But the thing that probably bothered her more was the fact that Lucy treated her like a cripple. It felt like she went out of her way to point it out. And the vast majority of people at the clinic followed her lead.

Not that they weren't nice. In her trauma classes virtually all the students seemed to hang on April's every word, eager to learn strategies that would help them handle trauma cases in the field. Unlike many of the other courses and training offered, which was often geared toward treating and stabilizing critical patients in Africa, before sending them on to partner institutions in the United States, most of what April focused on in her trauma lessons didn't require fancy technology, sophisticated systems or state of the art hospitals in order to be successful.

In theory, a checklist, mental or written, could be used in any circumstance.

And the students seemed to appreciate that. They asked good questions, respected when she didn't want them to talk, and vigorously participated in her prepared skills labs. But sometimes April found that her students could be  _too_  nice. They tried to stop her from running out into the courtyard with them to practice trauma drills. They tried to prevent her from climbing stiffly onto a gurney to demonstrate a technique on a dummy. They were always following her around with chairs.

It was infuriating.

"Everything alright, Dr. Kepner?"

April blinked, suddenly snapping out of her zone out and turning to face Dr. Fields, Porter and Alex. On her reading the other woman looked smug, which put April even more on edge.

"I'm fine," she replied tersely. Under her breath she muttered, "I don't need a freaking wheelchair."

Alex cleared his throat and walked over to April's side grabbing her elbow and guiding her away from the other doctors, "Okay...we've gotta go guys. Homework to grade. See you later."

When they'd reached the relative safety of their room, April scowled and pulled her arm away from her husband, as he looked on with a smirk.

"What?"

He crossed his arms, "Nothing."

"I'm fine!" April repeated firmly.

"Oh yeah? Because if looks could kill, I think Fields woulda been six feet under," Alex quipped. "It's actually pretty hot."

"I can't help it," April pouted. "Something about her just sets me off."

"Hey, I get it," her husband chuckled and flopped onto the bed pulling out his cell phone and poking at the screen. "She stole my freaking job, remember? But you know, I don't think we'd get away with it if we took her out. You'd totally blab."

April glared, "It's not funny, Alex. She treats me like an invalid. And then so does everyone else..."

Sighing heavily, April settled down on their bed too. Alex loved Nambosi clinic. He loved the work, he loved the students, the charity. Alex loved Malawi. And April had longed for so long to share this aspect of his life with him. Because she wanted to love what he loved and support him in his work. But it was barely 5 days in to their 14 day trip, April was starting to realize that she  _didn't_  love it there. Not at all.

It disappointed her.

April thought she would like Nambosi Clinic and and she wanted to very much. Especially given the recent distance that had cropped up between herself and Alex. She'd thought joining him in something he liked would reconnect them. But the harder April tried, the more obvious it was that this program, whether because of the location and distance from her home, her unease with her disability at the clinic, or the proximity to her husband's annoying ex, was not working for her.

She missed her children desperately. She missed her ER. She missed her car. She missed her friends. April missed it all.

When she was a girl she yearned to get as far away from home as possible. And for medical school and residency she really had. April had built her life in Seattle, miles away from her childhood home Cook, Ohio.

However, the older April got, the more she started to realize that maybe she was a homebody at heart.

"I know," Alex sighed, flopping down on his back. "Fields can be a bitch."

Closing her eyes April laid back to join her husband, curling close to his side, "I'm sorry. I just don't like the way she makes me feel is all..."

"Well, whatever. What Fields thinks doesn't even freaking matter anyway," he replied irritably. "It doesn't matter what any of them think. What matters is what  _you_  think!"

"But-"

"Only you can hold you down," Alex advised sagely. Almost wise. And  _very_  familiar.

April's eyes, widened in instant recognition and she propped herself up on one elbow to watch her husband in amusement, "When did  _you_  read my old notebooks?"

He shrugged playfully, "Found 'em in a box in the study when you went to that conference a few months back. You know you really worry too much about pointless crap. I mean, you are better now than you were back when you wrote all that stuff, but-"

"So you read them?"

"Once or twice. Whatever. I missed you."

April laughed and turned to face the ceiling, "Those were never meant to be read. Certainly no by you."

"It's not all crap," Alex added. "Some of the quotes and stuff were pretty good. Like that one. And all that other Oprah philosophical crap. Or the ones about me." He made a face am mimicked her voice, "'Alex Karev is a great pediatric surgeon'. "

She rolled her eyes. Once, years ago she would have been mortified for anyone, especially Alex, to read her small notebooks. But in this moment, April actually thought the idea that her husband read her old residency notebooks because he missed her was really sweet. At the time of writing them of course, April would have thought it was the end of the world.

Back then April had kept all her private thoughts in the pages of the small red objects. She actually still wrote sometimes, but now, with motherhood and a bustling career, she wrote far less. There were still things she had a hard time sharing with her husband however. These days those private thoughts and fears all related to her daughter.

Deep down, April knew that it was something she  _should_  talk to Alex about. For Audrey's sake. For Alex's sake. For the sake of their marriage. But...it was hard to face the possibilities. She couldn't actually be sure there was anything so wrong with her daughter, and she didn't know how her husband would respond if there was. She wasn't sure she  _wanted_ to Alex's family history, thinking that something might be wrong with Audrey was pretty unbearable.

And yet? Not knowing was somehow easier to face. Ignoring the question, in fact, not even asking the question in the first place, was far easier than facing the possible answer.

"'Alex Karev is  _so_  sexy'."

"I did not write that," April poked her husbands belly.

It was Alex's turn to prop up in his elbow. He watched her seductively, "Not yet!"

Biting her lip, April couldn't fight the grin that spread across her lips. He might do it unconventionally, but Alex always seemed to know just what she needed to calm down. He could divert her attention away from whatever was bothering her. He could always make her feel good about herself. And he was helping now.

But one thing was certain. April knew Alex couldn't make her love Malawi. He was good, but he wasn't a miracle worker.

April grabbed Alex's hand and laced their fingers together, speaking dejectedly, "I don't really think I like it here..."

He squeezed her hand and pursed his lips, "I know, April. We'll be home before you know it. But you are doing really great. Word on the street is that the trauma seminar is the student favorite this session."

"Oh yeah?"

"Yeah, pisses me right off, since peds is usually the popular one."

"Oh boo hoo," April teased before sighing once more. Even Alex's valiant attempts at distracting didn't make her feel much better. She did appreciate his efforts.

"I miss Adam and Audrey."

A lot.

Which was probably another huge contributing factor to April's heightened irritability in Malawi. Their old therapist, Dr. Wyatt would probably say that all the frustration with Fields and the dislike of Malawi was all really a means of deflecting from her real feelings. It was always easier to be angry than sad.

A rather ineffective coping strategy that both Alex and April had in common.

She knew it was cliche, but April's heart ached for her two babies. She dreamed about them and worried about them. Would Adam ever forgive her for letting go of his hand and leaving him behind? Would Audrey have another freak out under her parents watch? Were they really as okay as their parents brief emails said they were?

"Me too." Alex tapped his fingers on the side of his phone glumly. He glanced at his watch and grinned, "But I know just the way to cheer us up."

April found herself smiling to because she knew exactly what her husband was thinking. He wanted to call her parents and check in with their children.

"It's early for them..."

Alex rolled his eyes and started to dial, "It's a farm April. And I have slept at your parents enough times to know that you are all early morning freaks...it'll be fine."

* * *

Sitting in her study, Meredith squinted at the dim glow of the tablet screen in front of her. Changing the contrast seem to have no impact on the way that the words grew fuzzy right before her eyes. Neither did the angle she held her head or whether or not she wore her glasses. Then again Meredith had been researching and reading reports from some of the Canadian mammal trials on the pacemaker project for most of the day. Still the difficulty in reading after long periods of time unnerved her.

Ellis Grey had needed glasses to read before the end.

Derek teased Meredith about it, recalling the time she'd experienced vision loss as a result of their fertility treatments years ago. It was nice that now they could actually look back those times and feel more than just complete anguish, but needing glasses again was an unwelcome reminder to Meredith that she was getting older. Older, just like her mother had.

One step closer to Alzheimer's? It was definitely a worry.

Not that Meredith allowed herself to stop and think about her motivations very much, she suspected that deep down a huge part of her driving motivation for diving into the brain pace maker research was the fear she had of ending up like her mother. She'd taken the test once. To see if she had it. But the result was still carefully tucked away in her medical file. Neither Meredith nor Derek could bring themselves to read the results however. Not knowing was somehow easier to face.

Suddenly, a tiny pair of hands appeared before Meredith's eyes from behind the couch.

"Guess who?" Zola giggled covering up her mother's field of vision.

It was a game the Grey-Shepherd family had played on a regular basis ever since their daughter was very small. Zola was cheeky and outgoing and always loved to play a guessing game with her parents. Usually they tried to come up with outrageous, funny or unexpected answers that would make Zola laugh.

Today Meredith decided to rhyme, "Maya Angelou?"

"No!"

"Are you a chef from Le Cordon Bleu?" she continued to tease, lifting her hands to her daughter and patting them playfully. "I'm hungry."

Meredith realized that had no idea how long she'd been holed up in the study reading about the results of brain pace maker model studies on mice. She knew that she'd started her reading around lunchtime, having had the house to herself while Derek took their daughter to her soccer practice. But now it seemed dark outside.

"Daddy made spagetti!" the little girl laughed.

"It's Zola!" Meredith announced triumphantly, reaching up and pulling her daughter over her shoulders and into her lap with a heave.

The girl was not so small anymore, and the movement took more effort than it once had, and with a jolt, she realized that it wouldn't be too long before her little girl was too big for this kind of lifting. Zola snuggled close and peered inquisitively at the research on her mother's desk.

"How was your practice, Zo?"

The little girl shrugged, "It was okay, I guess. We're getting better, but I don't think we'll win our next game...it's hard. I don't wanna be a loser again."

"That's okay baby girl. You're trying. It's not all about winning," Mer comforted, knowing that this was actually one of the harder lessons she and Derek tried to teach their daughter.

"That's not what Aunt Cristina says..."

"Well, Aunt Cristina says a lot of things."

But Meredith new her twisted sister had a point. They were all surgeons. By nature and by their successes, both Derek and Meredith were intensely competitive people. And so was most everyone in Zola's life. They enjoyed 'winning' in the sense that they liked getting cases they wanted, the liked getting awards they felt they deserved, and best of all they liked beating the brain problems they treated. But Meredith had grown up as Ellis Grey's daughter, and she'd known Jackson Avery long enough to understand that growing up in that kind of environment, with incredibly successful and competitive parents, could be very demanding if not handled properly.

In some ways, Meredith was fortunate Ellis Grey was dead. Jackson's mother Catherine still continued to hover over her son about everything from his career's lack of 'flash', to his role in the Harper Avery foundation, to her lack of grandchildren. Being the child of a surgeon wasn't easy.

So she tried her best not to emphasize winning as the end all be all of life for Zola.

"Daddy made dinner?" Meredith asked. "Already?"

Zola nodded and pointed to an image of a mouse on the tablet screen, "Why do they have wires in his head?"

The girl didn't often show much interest in what exactly it was her parents did. She new that they were doctors and that they worked on people's brains, but usually zoned out when Derek and Meredith talked too much shop. It was kind of humbling actually. Their daughter never bowed at the altar of medical admiration the way a lot of other people did. Then again, given that most of the parents Zola's closest friends and a good number of her family members were all surgeons, the feat probably didn't seem all that unusual or impressive to her.

"The scientists are using the wires to deliver a little jolt of electricity to the mouse when neural pathways collapse," Meredith explained eagerly. "That way the mouse doesn't loose his memory."

Her daughters face scrunched up, "How do they know if a mouse is forgetful?"

"They check if he remembers where he hides his food, where he sleeps, how to get out of mazes. Stuff like that."

"Why do they even care if a mouse forgets things?"

"Because these mice have a disease called Alzheimer's. It's a disease people get too, and since we're both mammals it causes similar damage to the brain. If they can figure out how to stop it in mice with electricity, they might be able to help people too."

"Alzheimer's," Zola's tongue formed the word very carefully. "That's very bad, huh?"

Meredith considered the question carefully. She supposed with neurosurgeon parents, Zola had definitely heard the word before. She'd certainly been present for many conversations about most of the kinds of conditions Meredith and Derek treated on a regular business. Like most children, she seemed to shut a lot of the talk out, but she supposed something was bound to have cut through. Even if Meredith hated to talk about it.

"Yes," she answered. "It makes you lose all your memories..."

Zola frowned and glanced up to Meredith, "Your mom had it, didn't she?"

Meredith had no idea how Zola knew that, because she honestly had never talked about Ellis Grey very much with her daughter. Ellis and Zola represented two completely different lives for Meredith and she really didn't want them to overlap. And Zola never really asked about her grandmother, because she was close with Derek's mother. Or so Meredith thought.

"She did."

The girl swallowed. "Daddy said it can be her-reditary...like passed down in families and stuff. Well...not adopted ones."

Involuntarily, Meredith felt her arms tighten around Zola as she nodded.

The girl must be getting her information from Derek. Though she couldn't understand why the hell such a weighty subject might come up between father and daughter. It's not the kind of thing you should talk about with a 9 year old. She made a mental note to chastise her husband.

Zola turned back to face her mother and asked seriously, "Will you get it?"

The question almost broke Meredith's heart. It was actually one of her greatest fears. Meredith hated the idea of losing her mind. Forgetting her husband. Forgetting Zola. Forgetting who she was. Meredith did not want to end up like Ellis Grey. She knew she had the genes at the very least.

Whether they would work together at some point and cause her to lose her mind was out of control. Whether there was a treatment that could prevent or cure the disease by the time Meredith did find out whether her DNA would betray her was something that she had control over. That's why she was determined to explore this pace maker idea.

Even if the whole thing went far past the line of emotion and separation that surgeons are supposed to maintain. She had to push and take part in Alzheimer's research.

"I don't know honey," Meredith finally responded. "I hope not..."

"Me too, Mom," Zola swallowed and leaned close. "But don't worry. If you get it, I'll help you remember your life. I'll take care of you. I promise."

As freely and sweetly as the offer was made, Meredith knew exactly what taking care of a parent with Alzheimer's entailed, and she knew that it was the last thing she wanted for her daughter. Her mother's illness and the words that it caused her to speak hurt Meredith more than she liked to admit.

Zola's words reinforced her conviction to pursue her research even more. She needed to get approval for clinical trial. She needed to figure this out. She needed to do everything she could to stop Alzheimer's disease from ruining families.

Meredith  _needed_  to protect Zola from herself.

* * *

"Alright," Alex clapped his hands together, as the last of his medical students filtered into the cramped classroom, quieting the last of the chatterers. "So, today we're gonna talk about making tough calls in medicine. The hard decisions, sometimes even life or death ones, that have to be made as a physician. We all know that is hard with any patient, and we also know that it's even harder to make the tough calls when the patient is a kid."

Ten days into his crash course in pediatric surgery basics, and Alex had reached his least favorite, but probably also one of the most important lessons. When to face reality. It was hard enough to do with any patient. It was hard to make that switch from life saving to end of life care. It was hard to know when to let go.

Especially with kids. Even when the stakes weren't that high, treating children you knew you couldn't cure was a challenge.

Looking around the room, Alex saw a cascade of somber expressions appear across the faces of his normally lively class. The kind of expression that revealed that several of his students at least, had dealt with this kind of situation with patients before. Which made sense. A huge part of the reason the Africa program existed in the first place was to help doctors in places like Malawi achieve the best possible kinds of outcomes for their patients.

Outside in the distance, Alex could vaguely hear the sound of his wife's voice on the wind as she ran another skills lab in the clinics central court yard. He knew she hadn't exactly fallen in love with the place, like he had after Robbins had gotten him involved in the project in the first place. April was trying hard to have a good time, but Alex could see the truth. She put on a good show.

And it was actually cool. Alex was glad she had the chance to see his work outside of Seattle, even if he was fairly certain that this would be April's only trip to Malawi. It was all that give and take crap in marriage. In the same way he didn't exactly  _love_ cooking or chick flicks or helping out his father in law on the farm yet he still did all that stuff with April, she was returning the favor in Malawi. And doing a decent job with trauma class to boot.

Which pissed Fields right off, much as the other woman tried to hide it. There was a  _reason_  she had transitioned over to the admin side of things at Nambosi clinic.

April was a better teacher than Lucy. She was more effective, more fair and more approachable for students than the stony faced OB/GYN. In her short time at the clinic, April was also more popular among the students too and Fields knew it. So, she pushed April's buttons. Alex tried to stop the catty back handed stuff he saw going down between his wife and his ex girlfriend whenever he saw it, because he was damned if anyone, especially Lucy of all people, would treat his wife without complete respect.

But frankly he felt a bit out of his depth.

Honestly, they way chicks fought didn't make any sense to him. At all. If they were dudes, April and Lucy would just go outside and beat the crap out of each other. And April would win (he knew she freaking would) and that would be the end of it. Full stop. Close the freaking book.

Chicks would smile at each other to their faces and then talk shit behind the other's back. They'd do little tiny things that they knew would bother the other person. They'd let the whole conflict gnaw away at them for days.

Alex just didn't get chicks sometimes.

He noted that many of his own students gazed longingly toward the windows. Today, the consensus seemed to bethat trauma class would definitely be more fun.

Swallowing hard, Alex pressed on, "The key thing to remember though, is that in any situation, no matter what, there is always  _something_  you can do for your patient. It might not be the something you want to do. You might not be able to fix their hurt, cure their disease or make them well again, but there is always something you can do to make them comfortable."

The solemn class in front of him nodded.

In the front row, one of Alex's more promising students, Mercy Unganwo, seemed to be thinking deeply. Her strong features were set in a frown, though her determined jaw was set, as always. She was one of the more interesting students too. Her ending up in medical school was nothing short of a miracle given her family background and origin in one of Malawi's isolated rural villages. A generous donation to the Africa Projet's endowment from the Harper Avery Foundation, courtesy of freaking Jackson, allowed for the program to host the kinds of scholarships that even allowed Mercy to study at Nambosi clinic.

She didn't talk much, but Alex was consistently impressed by her performance in skills labs and her articulate essays. She was smart. She was passionate.

It was like Robbins always said about Alex. You just  _know_  when someone is good for peds.

Mercy was one of those people. What he wouldn't give to trade her out with some of the idiot residents he had to deal with back in Seattle. Sometimes it seemed like those students just failed to appreciate their education at one of the country's best teaching hospitals. The stuff they freaked out over. They didn't know how lucky they were.

"So, alright," Alex continued slipping his hands deep into his lab coat pockets and fidgeting with the remote in his pocket. "You are probably wondering what I mean by 'something'. If you can't help really, then what can you do?"

The class whispered among themselves and continued watching intently, while Alex fidgeted with his pockets. He knew what he wanted to talk about. Which memory of which patient he was going to use to illustrate the major point of the lesson. It was the same example he always used. He wanted to tell them about a young cancer patient he'd cared for years ago who'd died of end stage cancer named Marcello Conti. In the end, there was a shift in his care from life saving to end of life treatment.

Marcello's loss was a big one for him. April had helped Alex learn the very lesson about tough medical decisions that he wanted to teach his students today, and in the end it had also turned out to be the reason he told her that he loved her for the first time.

But it was still hard to talk about. Crap like that was always hard for him to talk about. So Alex stalled.

"How many of you hear have dealt with patients were you had that moment? When you realized that nothing you could do would make them healthy again? Show of hands?"

Dr. Wyatt, his old therapist, said Alex did crap like that because he thought that putting stuff off would make it hurt less when he actually had to talk about it. Like people who thought that pulling a bandaid off slowly was better than ripping it off in one go. In that session, while April snickered, Alex had calmly informed the psychologist that saturating a bandaid in baby oil messed with the adhesive enough so that it could be pulled off at any speed without pain to the skin.

Alex was a pediatric surgeon after all and a father. He knew things.

Wyatt told him he was missing the point.

About half of the students raised their hands slowly. Alex nodded. Many of the kids int he program had some experience practicing medicine in the field, but the depth of that experience varied.

"Not with a patient but..." Mercy mumbled as her brow furrowed and she skeptically lifted her hand in the air. She was the last of the group to do so.

Leaning back against his desk Alex nodded, "Okay so, it looks like many of us have already experienced this kind of moment. For those of you that haven't, you can't be a doctor and not encounter this. Don't worry. It's coming."

The gravity of the topic didn't stop a small round of laughter at his attempt to lighten things. Taking a deep breath, Alex glanced around the room. It was now or never.

"Um, when I was a 5th year resident," he explained haltingly, pressing the button on the remote in his pocket and activating the first slide of his power point. "I was treating this kid, Marcello..."

An image of the sickly teen appeared, surrounded by Alex, April, Cristina, Mer and Jackson as they hung out in his room studying for boards. Along side the image bullet points detailed Marcello's condition, and Alex began to walk his class through the development in his case during the last weeks of the boy's life. He used this case as an example because it was one that really stuck with him, and because one of the teenagers dying wishes was for his life to mean something. And even though he didn't live very long, Alex at least figured his legacy would come from the students Alex shared his story with.

"In the end his tumor grew to the point where it eroded his lungs," Alex winced as he flipped to the slide that contained Marcello's final chest x-ray. It was pretty bad. "He experienced increasing breathing issues. Now, his family, like I said, lived far away. And they were on their way but...well, his condition wasn't great." He pointed to his chest, "So you wanna know what course of action this genius argued for?"

Hands shot up instantly. Alex pointed to the one he'd seen first, Robert Saka.

"To give him doses of medicine that would ease his pain and respiratory distress? Morphine or something such as that? To mak him comfortable in his final moments?"

"That's what we ended up doing. That was the right course of action in Marcello's case. But, I wasn't used to making tough calls yet. I argued that we try an experimental procedure that had only been tried a few times for cancer patients."

The students looked around in shock. They seemed to think it was crazy that Dr. Alex Karev could and did make mistakes. Which still caught Alex off guard. Having success was still a surprise to him.

"Everyone screws up," Alex shrugged. "Especially when you are close to the patient. In this case the best thing for Marcello was to make him comfortable and keep him company until he passed. That was all we could do. It was tough for me to face, but fortunately I had people around me that helped me see the truth. Once I did, I totally was on board with the course of treatment. Because  _of course_  another surgery was only going to make things worse and  _of course_  he'd rather die being hugged by people that cared about him than cut open on a surgical table. For his case, this was clearly the way to go."

The description seemed to hit some people. Even when you dealt with poverty, lack of resources and death every day, if was still difficult to hear about a loss. Some students dabbed at their eyes. Others sniffed. Mercy looked at her hands.

"Honestly sometimes the hardest thing to do, as a doctor and in life, is face a reality that you don't like. Sometimes the truth will freak you out. Sometimes it'll piss you off. Sometimes it'll make you feel powerless. It can cloud your judgement enough that your actions are more what is best for you and your feelings than they are for your patients. Fantasy land crap. But you know what? You can't be that effective until you face what is ahead of you..."

Alex swallowed hard and concluded, just as the clock signaled the end of his lesson, "Learning how to get better at accepting the truth is actually one of the hardest parts of your job. Especially when you know that medicine is capable of great things. It just doesn't work for everyone. Or every kid. Some food for though. Thanks and see you guys tomorrow."

As the class began filtering out, Alex turned to shut down his laptop. When he closed down the power point, his desktop background greeted him, and made him swallow hard, given the nature of his lesson. It was an image of his family. Amber, April and himself, plus the three kids grinning on the front steps of his house. Well Kyle and Adam were grinning anyway. Audrey was sitting on his lap, with a more blank expression, seemingly more focused on rubbing her fingers along the Velcro if her shoe than anything else.

Alex might have gotten a handle on making tough calls in medicine, but he was crap at facing reality in his own life. He knew better than probably anyone other than his sister Amber, just what kind of crazy that existed in the Karev family. It was DNA. Between his mom and Aaron, who both had incredibly complex mental health problems there was a distinct possibility that Audrey had inherited  _something,_ even though the thought left him sick to his stomach.

The older Audrey got the more clear it was that she wasn't exactly normal. The distance and time away from her in Malawi had given Alex time to think. April too, not that she'd said anything to him about it, a fact which made him feel grateful. He wasn't ready to talk about it, but he was ready he supposed to use the trip as a time to evaluate things. The trip was giving them both time to think.

To look at the situation more objectively without being around the toddler 24/7. It's amazing what you can normalize to when you are around it everyday.

In the emails and skype calls Alex and April had shared with her parents to check on the kids, it was clear that Joe and Karen were getting run down. And while they never came out and said it, Alex would bet money that the reason they were getting exhausted was because of his daughter. What was it Joe had said in the last call? Or Karen in the one before that? Sometimes in the video chats it looked like they'd only barely managed to get the little girl dressed. Sometimes it looked like they hadn't at all.

Audrey is a handful. That's what people said.

Alex had several probable ideas as to  _why_  people said that, but he honestly wasn't sure he could handle actually knowing why. He didn't think he could hold onto his own sanity if he found out his daughter really had inherited a condition. He didn't think he could live with the guilt. Because it would be his fault she had it. April's family was full of freaks in their own right, but none of them actually had a mental heath disorder. They fought but none of them ever tried to kill a sibling.

He didn't think he could live with the guilt.

After all the other students had left, Mercy lingered behind. Alex looked up thoughtfully when he realized she stayed behind.

"This was a good class today, Dr. Karev."

"Well, uh...whatever. It's something we all have to learn."

Mercy sighed heavily and nodded, "Yes. It is."

He didn't know the young woman well, and he wasn't exactly one of those touchy feely kind of teachers, but he could tell that she had been deeply impacted by the days lesson. And for whatever reason, Alex was drawn to this student. He liked her . She reminded him of himself in a lot of ways. Remembering her earlier comment he decided to prod.

"What did you mean, earlier in class? When we raised hands. You said you had experience making tough calls and facing reality, but not with a patient?"

Something flashed in Mercy's eyes and for a second, Alex thought he'd blown it completely. He half expected Mercy to turn on her heel and run out of the room.

Finally she shrugged, and stated, "Once in my village, when I was...perhaps 14? Many became sick. Many children. I had five brothers when the sickness came. Now, I have three."

Realization dawning, Alex's eyes widened.  _Damn._

"Ah..." He didn't really know how to respond. "That sucks."

Nodding, Mercy approached Alex's desk and pointed to his computer screen, "Is that your family? I recognize Dr. Kepner..."

Happy enough with the change of subject, Alex smiled proudly and pointed to the picture, "Yup. Those are my kids. Kyle, Adam, and Audrey."

A hint of a smile crossed Mercy's lips, "They look like you too. Well, except..."

"Yeah, Adam looks like April," Alex chuckled. "It's mostly the hair..."

"They are all very beautiful."

Alex beamed, "I like to think so."

The student's expression became thoughtful again, "This was a very good class today, Dr. Karev. Something we all can find useful."

"That's the idea."

"It is difficult to accept things."

"Yeah. Sometimes it really is," Alex agreed.

"Especially for your own family," Mercy continued. She paused and then added almost to herself. "It will be easier as a doctor."

"Maybe."

Shaking her shoulders slightly, Mercy slowly gathered her books and turned towards the door, "We must accept things, even when they are hard, right Dr. Karev? It must be done."

"Er, right," Alex replied awkwardly watching the girl leave his classroom. He let his mind and his thoughts wander back to the image on his desktop screen. He swallowed hard, looking for a long time at Audrey.

It must be done. Some thing must be done. He was her father. There had to be  _something_ he could do for her.

But what?


End file.
